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Child Well-Being Infrastructure

Louisiana’s Office of Children’s Ombudsman is a missing piece of child well-being infrastructure. I believe the concept of “Child Well-Being Infrastructure” is essential. I think I can explain.

Louisiana’s leaders frequently speak about “infrastructure.” As a result, infrastructure is a common topic in Louisiana’s news. For example, a few days ago, the Louisiana Governor’s Office (@LouisianaGov) tweeted that “thanks to the infrastructure investment and Jobs Act and the leadership of Sec. Harris and his team, we have been able to hit the ground running in plugging the orphaned wells in Louisiana.”

Infrastructure.

Construction projects are tangible, and the benefits they offer are measurable. Moving earth and water, and concrete and steel is progress. Yet, despite our state’s energy around infrastructure in the physical world, Louisiana has never created critical pieces of “child well-being infrastructure.”

During my recent presentation to the Baton Rouge Press Club about Louisiana’s missing Office of Children’s Ombudsman, a phrase came to mind that I hope may help explain in practical terms the impact of Louisiana’s missing pieces of child well-being infrastructure on the well-being of our children.

In my presentation, I noted that other states doing better by their children have something we do not have in Louisiana. I found myself saying, “it’s a piece of ‘child well-being infrastructure’ that we lack in Louisiana. Most states offer ombudsman services for children. Louisiana does not.”

I have since Googled the phrase “child well-being infrastructure”, and Google returns no results for the exact phrase. So, tongue in cheek, I claim it for Louisiana’s children! #ChildWellBeingInfrastructure (Surely, in the pages of a child welfare research paper, the phrase has been used before, so I will keep my eyes open for the original use.)

Still, as little as Google knows about it, I believe the concept is essential.

Imagine Louisiana without levees, our bayous without bridges, petroleum fields without pipelines, or cities without sewers. Louisiana’s engine of progress would grind to a halt due to missing infrastructure. Systems with missing pieces fail. Progress must have all the parts required to move forward!

We must have infrastructure!

Louisiana’s “child well-being infrastructure” needs attention badly. I believe Louisiana continues failing our children because we have not yet created the infrastructure required to care for kids successfully. We must help Louisiana’s leaders understand that the Office of Children’s Ombudsman is not the only missing piece of child well-being infrastructure. Other missing infrastructure elements necessary to improve child well-being include Child and Youth Planning Boards and Citizens Review Panels.

Also, Louisiana provides what I have often called “placeholder services.” Those are the services Louisiana delivers just enough to say, “yes, we do that.”

A good example is the Coordinated System of Care (“CSOC,” pronounced “sea sock”). With more than One Million Children in our state, Louisiana limits the number of CSOC participants to 2,400, making the service available to only 0.0022% of our children.

Nurse-Family Partnership (“NFP”) is another critical service with a long history of incredibly positive outcomes. In 2022, Louisiana budgeted to provide NFP services to only 2,300 babies. Yet, NFP has data from across the nation indicating it is a successful service that also provides a great return on every dollar a state invests in the program.

Louisiana funds NFP with Medicaid dollars, so there are restrictions on eligibility. Not every new mom and baby is eligible to receive NFP services – but many are.

In 2020, 61.4% of Louisiana mothers had Medicaid at the time of birth. In 2020, there were 57,328 live births in Louisiana. Given these numbers, 35,199 babies were born under Medicaid coverage. If about 40% of Louisiana’s births are to first-time moms (another requirement), then one can estimate that 14,080 babies would be eligible for NFP services. Even if only half of the eligible moms (7,000) desired participation, two out of three would be disappointed. Louisiana funds less than a third of the desired services and only 16% of the services required to care for all who are eligible.

With that in mind, while Nurse-Family Partnership services began in Louisiana in 1999, it is easy to understand why NFP is still only a placeholder service. But, of course, there was hope for growth along the way.

An expansion plan submitted by LDH to the Senate Health and Welfare Committee in response to Concurrent Resolution 70 of the 2008 Regular Legislative Session called for a phased-in expansion of NFP to serve 50 percent of eligible women in Louisiana by 2014-15. Fifteen years later, Louisiana funds Nurse-Family Partnership to provide services to only 16% of eligible babies.

Louisiana’s leaders frequently speak of “investments in infrastructure.” But, perhaps our budget makers are short-changing Louisiana and its children.

Forty years of Nurse-Family Partnership data and economic research from across the nation indicates that Louisiana would receive a 5-fold return on each dollar spent on Nurse-Family Partnership services. According to NFP, every $1 saves $5.70 in future costs for the highest-risk families served. That’s a 570% return! Does that not seem like a piece of Child Well-Being Infrastructure where Louisiana should be pouring funds to care for every eligible mother and her baby?

Louisiana lacks many pieces of child well-being infrastructure. One-by-one, we must create the missing pieces for the sake of our children and for Louisiana’s future.

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